Provider Demographics
NPI:1962880716
Name:HHC OF SOUTHWEST FLORIDA LLC
Entity type:Organization
Organization Name:HHC OF SOUTHWEST FLORIDA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:POTOCHNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-206-1150
Mailing Address - Street 1:840 111TH AVE N
Mailing Address - Street 2:SUITE #7
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1877
Mailing Address - Country:US
Mailing Address - Phone:239-206-1150
Mailing Address - Fax:239-206-1160
Practice Address - Street 1:840 111TH AVE N
Practice Address - Street 2:SUITE #7
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1877
Practice Address - Country:US
Practice Address - Phone:239-206-1150
Practice Address - Fax:239-206-1160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299994459OtherHHA LICENSE